Cystine lithiasis: combined extracorporeal and litholytic treatment.
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16 patients with calcic nephrolithiasis and renal failure were admitted to our institute and underwent surgery. 4 patients had bilateral nephrolithiasis and 12 cases had relapsed. Selective nephrotomy was performed in all cases, pyelotomy was done in 8 and partial nephrectomy in 2 patients. In 8 patients renal function improved but no difference was observed in 6 patients. Renal function worsened in 2 patients who had shown significant preoperative proteinuria. According to our experience, the success of this therapy depends on: (1) accurate patient selection; (2) adequate preoperative treatment, and (3) personalization of surgical management.
We evaluated the degree of kidney damage in 175 patients treated by nephrectomy for recurrent renal stones. Renal histopathological lesions of the removed kidneys were graded and correlated to clinical and operative findings. Nonexcreting kidneys on intravenous pyelography or small atrophic kidneys with poor contrast excretion showing advanced hydronephrosis and pyelonephritic scarring intraoperatively corresponding to kidneys with advanced parenchymatous destruction histopathologically. In 91% of the cases severe renal damage was correctly predicted, and a decision to remove the affected kidney was justified.
By the use of simple quotients consisting of the lithogenic variables in the numerator and the litholytic ones in the denominator as well as of complex chemical and discriminant analytical computational use of urine parameters, it is possible to distinguish significantly between groups of control persons and recurrent calcium oxalate stone formers and to obtain a relative prediction concerning the risk of stone formation. In discriminant analytical computation, in our opinion, it is most convincing to make use of variables which have been checked multivariately concerning their separating properties with regard to their mutual correlations and their measure of indispensability.
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We report the case of a patient with pain and an abdominal palpable mass whose tests showed a left pelvic kidney with a 1.5-cm stone in the renal pelvis. We describe the successful management through videolaparoscopy-guided percutaneous transperitoneal nephrolithotripsy, stressing that this method is a therapeutic option in such cases.
INTRODUCTION: Due to the evolution of extracorporeal lithotripsy equipment (ESWL) and presently, the fact that most part of the equipment does not present ultrasound to localize urinary calculi, a system that allows adapting ultrasound equipment to ESWL equipment was developed, disposing only of fluoroscopy. Thus, this equipment was developed and was tested in urinary stones in canine models, to check its precision in relation to fluoroscopy. METHOD: Seven male dogs were utilized with the introduction, in the bladder through the ureteral route, of chalkstones, with initial localization by fluoroscopy, with a further ultrasound coincidence check localization of the vesical stones, being submitted to ESWL with a 3-hour, 21 days and 60 days follow-up after the procedure. RESULTS: Success of localization in all animals was verified presenting elimination of stones in the first micturitions, after ESWL. No complications were verified in those animals for 60 days. CONCLUSION: We verified that this equipment can lead to an update of the equipment that use only fluoroscopy, increasing in this way, their technical capacity in the treatment of urinary calculi, mainly in cases of non-radiopaque stones.
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The occurrence of biliary calculosis as a complication of the use of ceftriaxone was first described in an 18-year-old patient with chronic granulomatosis. Since then many reports have been published on this type of complication both in children and in adults, but until the present moment, this complication had never been reported in pre-term neonates.The authors describe two cases of biliary calculosis associated with the use of ceftriaxone in preterm-newborns, emphasizing that due to the frequent use of this type of antibiotic in neonatal I.C.U., routine ultrasonographic control exams should be performed to diagnose this possible complication in all neonates receiving ceftriaxone.
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We present a review of the treatments of the urinary calculations carried out in the Lithotrity Unit in its first five years of working with the Dornier lithotriptor MFL-5000. We describe the location and size of the calculations, distribution by age and sex of the patients, energy applied and time employed, and we compare our retreatment index and the number of sessions per calculation with those published by other authors.
One hundred and eighteen consecutive patients presenting with pancreatic calculi have been studied by means of plain films of the abdomen and endoscopic retrograde cholangiopancreatography. Patients were divided into the following groups: 1) Evenly calcified calculi, 74 patients, 66 men, aged at onset (M +/- SM) 40 +/- 10 years; daily consumption of alcohol, 157 +/- 121 g, and of tobacco, 26 +/- 15 cigarettes. Two patients presented with another case in the same family. Composition of calculi--at least 95% calcium salts and a degraded form of lithostathine S (formerly called PSP S2-5)--was similar in the Occidental alcoholic and in the tropical form: calcified calculi are probably related to alcohol and nutritional disorders. 2) Radiolucent stones, 17 patients, 12 men and 5 women, aged at onset 38 +/- 18 years. These patients had a low alcohol and tobacco consumption. There were four familial cases. 3) Radiolucent core with a calcified shell (target calculi), 27 cases, 23 men; age at onset, 38 +/- 15 years; daily ethanol consumption, 111 +/- 93, and tobacco, 19 +/- 15 cigarettes. There were two familial cases. It has been shown that these calculi originated from transparent calculi that later calcified. The frequency of women and of familial cases was significantly greater in groups 2 + 3 than in group 1. The consumption of alcohol and tobacco and the proportion of men were significantly lower in group 2 than in groups 1 and 3. We discuss the role of heredity in lithostathine precipitation and of alcohol in calcium precipitation.(ABSTRACT TRUNCATED AT 250 WORDS)